Zhou Ting, Liu Chaobing, Zhang Songlin
Department of Cardiothoracic Surgery, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China.
Department of Cardiothoracic Surgery, Yichang Central People's Hospital, Yichang, China.
Front Cardiovasc Med. 2022 Oct 11;9:915874. doi: 10.3389/fcvm.2022.915874. eCollection 2022.
Coronary artery to pulmonary artery fistula (CPAF) is a congenital or acquired abnormal channel between arteries, with a left-to-right cardiac shunting, which may lead to myocardial ischemia, arrhythmia, thrombotic complications, and heart failure. CPAF is usually detected by coronary angiography but few reports have used beating-heart surgery as a detection method. The patient in this case report is a 39-year-old male diagnosed with atrial septal defect (ASD), bicuspid pulmonary valve, and moderate tricuspid regurgitation (TR). He is asymptomatic. In preoperative evaluation, significant CPAF was suspected using echocardiography. The patient refused coronary angiography due to allergic history. Therefore, the cardiac team designed and performed on-pump beating-heart surgery (OPBHS) to detect and repair these disorders, and suggested OPBHS as a myocardial protection strategy for the patient at low surgical risk. A rare and complex cardiovascular case with CPAFs from two branches of the left anterior descending coronary (LAD) artery to the main pulmonary artery (MPA) with ASD, bicuspid pulmonary valve, and moderate TR has not yet been reported in the literature, and its embryological hypothesis has been further analyzed in this report.
冠状动脉至肺动脉瘘（CPAF）是一种动脉之间的先天性或后天性异常通道，存在左向右的心脏分流，可能导致心肌缺血、心律失常、血栓形成并发症和心力衰竭。CPAF通常通过冠状动脉造影检测，但很少有报告将心脏跳动手术作为检测方法。本病例报告中的患者是一名39岁男性，诊断为房间隔缺损（ASD）、二叶式肺动脉瓣和中度三尖瓣反流（TR）。他没有症状。在术前评估中，通过超声心动图怀疑存在明显的CPAF。由于过敏史，患者拒绝进行冠状动脉造影。因此，心脏团队设计并实施了体外循环心脏跳动手术（OPBHS）来检测和修复这些疾病，并建议将OPBHS作为该低手术风险患者的心肌保护策略。左前降支冠状动脉（LAD）两个分支至主肺动脉（MPA）的CPAF合并ASD、二叶式肺动脉瓣和中度TR这种罕见且复杂的心血管病例在文献中尚未见报道，本报告进一步分析了其胚胎学假说。
